Translating probiotic science into practice

Scientific and clinical evidence on the health effects of probiotics has expanded rapidly in recent years and points towards benefits for a number of specific health conditions, particularly those related to the gut. Healthcare professionals are important conduits in the transfer of evidence‐based messages on probiotics, but research indicates many do not consider themselves to have good knowledge in this area. To identify potential solutions to support healthcare professionals, the British Nutrition Foundation held a one‐day roundtable event on 7 February 2019 to gather expert views on the content of, and best delivery mode for, evidence‐based resources to guide healthcare professional advice about the use of probiotics. This report describes the main themes emerging from the discussions and the group's recommendation for the development of a UK‐focused online toolkit for healthcare professionals, which assimilates, appraises and translates current scientific knowledge of probiotics to promote evidence‐based practice for the benefit of patients.     

Diet‐derived microbial metabolites in health and disease

The gut microbiota helps us digest food and has been associated with both good health and risk of disease. Although compositions of the gut microbiota are highly divergent, the gut microbiota exhibits a high level of functional redundancy making it difficult to reliably link gut microbiome patterns to health and diet across individuals. Thus, there is a need to move beyond profiling of the gut microbial composition to the assessment of gut microbial metabolic activity in order to expand knowledge on the impact of the gut microbiota on health. Metabolomics has already proven its utility in identifying gut‐derived microbial metabolites, which may be mediators of diet‐induced host–microbial crosstalk important for health. These diet‐derived metabolites include, among many others, the short‐chain fatty acids originating from bacterial degradation of dietary fibres and proteins, secondary bile acids derived from primary bile acids, microbial tryptophan catabolites resulting from proteolysis, imidazole propionate produced from histidine and trimethylamine N‐oxide, a host–microbial co‐metabolite of nutrients such as phosphatidylcholine, choline and L‐carnitine, present in high‐fat foods. These co‐metabolites have been associated with beneficial and detrimental effects in the host. However, the vast majority of metabolites measured by untargeted metabolomics in human blood and excreta remain unknown and may include additional microbial molecules of importance for health. Thus, there is great potential, yet to be explored, for identifying additional diet‐derived microbial products that affect the host. Herein, we review key advances, challenges and limitations in our understanding of diet–microbiome interactions and diet‐derived microbial metabolites in relation to human health and discuss how metabolomics may shed light on inter‐individual differences in dietary responses.     

The use of chewing gum for postoperative ileus prevention in patients undergoing radical cystectomy

Does the postoperative use of chewing gum in patients undergoing radical cystectomy (RC) facilitate intestinal motility recovery, reduce intestinal recanalization times and decrease length of stay? Postoperative ileus is a temporary impairment of intestinal motility and a frequent complication after RC. It is characterized by abdominal distention and absence of bowel functions, with symptoms including nausea, vomiting, pain and cramps. This results in an increase in length of stay, patient discomfort and costs. Different studies investigated the efficacy of chewing gum use, as a form of simulated feeding, in accelerating the resolution of ileus after several abdominal surgical procedures. Considering the lack of specific studies, some other conducted in similar abdominal procedures were included in this literature review. Despite the diversity of type of surgery, all considered studies show for patients who received chewing gum, a significant reduction in the time of first flatus and faeces, a reduction in the time of first bowel movements; not all included studies instead have found a significant decreasing in morbidity and length of stay. The chewing gum use seems to be a simple and inexpensive way to enhance recovery of bowel function, although it is probably still a little known procedure. It is possible recommending the administration of chewing gum in patients after cystectomy, monitoring the effectiveness, upon the recognition of possible conditions that might contraindicate its use.     

术前负性情绪对直肠黏膜脱垂患者吻合器痔上黏膜环切术后疼痛的影响

[目的]研究直肠黏膜脱垂患者吻合器痔上黏膜环切术(PPH)术后疼痛与术前负性情绪的相关性.[方法]选择2013年1月至2015年6月在本院确诊为直肠黏膜脱垂并进行PPH手术治疗的100例患者为研究对象,对其进行术前焦虑及抑郁程度评价,对其术后疼痛进行调查评分,分析PPH术后疼痛相关影响因素及其与术前负性情绪的相关性.[结果]女性24 h、48 h、72 h视觉模拟量表(VAS)评分均显著高于男性;未婚或离异患者VAS评分均显著高于已婚患者;自费患者VAS评分均显著高于医保、新农合患者;负性情绪组VAS评分均显著高于非负性情绪组,差异均具有统计学意义(均P＜0.05).患者术前焦虑、抑郁负性情绪均与患者术后24 h、48 h、72 h VAS疼痛评分呈显著正相关,差异均具有统计学意义(均P＜0.05).[结论]大部分直肠黏膜脱垂患者术前均存在负性情绪,而患者术前焦虑、抑郁负性情绪对患者术后疼痛程度呈正相关性.     

溃疡性结肠炎首次拟行粪微生态移植术患者的健康需求

目的了解首次拟行粪微生态移植术(fecal microbiota transplantation,FMT)的溃疡性结肠炎(ulcerative colitis,UC)住院患者对健康教育的需求,以便采用更合理的教育方式。方法 2015年5月至2016年10月,便利抽样法选取在解放军总医院消化内科首次拟行FMT的UC住院患者62例为研究对象,采用自行设计问卷对其进行疾病相关知识的认知状况和健康教育需求调查。结果本组患者对疾病相关知识普遍缺乏了解,72.58%~80.64%的患者对药物治疗、饮食治疗、诱因、并发症不了解,87.10%~96.77%的患者对治疗的不良反应、术后注意事项及治疗效果不了解。91.94%~100.00%的患者强烈需求用药常识、饮食护理、心理指导、FMT不良反应、FMT术后注意事项及FMT的效果等方面的健康教育;82.26%~87.10%的患者强烈需求出院指导、FMT的目的等方面的健康教育。患者选择最多的健康教育方式是床旁个体指导,共54例,占87.10%;而患者对健康教育实施者的选择显示,选择医护合作的53例,占85.48%。结论根据首次拟行FMT的UC患者对相关知识的认知和健康教育需求的情况,给予针对性的健康教育,可确保健康教育工作获得最佳效果。     

肠道寄生虫病的化学药物治疗

本文综述了化学药物在治疗肠道寄生虫病中的应用及不良反应和注意事项。     

Aggressive surgical management for advanced colorectal endometriosis

PURPOSE: The aim of this study was to evaluate the results of aggressive surgical management in patients with advanced colorectal endometriosis. METHODS: The medical records of 130 women who had undergone aggressive surgical management of advanced colorectal endometriosis were reviewed. They were then interviewed a mean of 60 months following surgery and asked to rank relief of their symptoms. RESULTS: The most common symptoms before surgery were pelvic pain, dyspareunia, rectal pain, change in bowel habit, and cyclic rectal bleeding. Colorectal operations included low anterior resection, sigmoid resection, disc excision of the rectal wall, right colectomy, appendectomy, and small bowel resection. At follow-up symptom relief was high, ranging from 100 percent in cyclic bleeding to 91 percent for rectal pain. Mortality and clinical leakage rates were 0 percent, small bowel obstruction 3 percent, and abscess 1 percent. The crude pregnancy rate following surgery was 49 percent. CONCLUSIONS: These findings strongly support the use of aggressive surgical extirpation of all visible colorectal endometriosis for patients with advanced disease.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.     

Adhesion and immunomodulatory effects of Bifidobacterium lactis HN019 on intestinal epithelial cells INT-407

AIM:To elucidate the adherence and immunomodulatory properties of a probiotic strain Bifidobacterium lactis(B.lactis) HN019.METHODS:Adhesion assays of B.lactis HN019 and Salmonella typhimurium(S.typhimurium) ATCC 14028 to INT-407 cells were carried out by detecting copies of species-specific genes with real-time polymerase chain reaction.Morphological study was further conducted by transmission electron microscopy.Interleukin-1β(IL-1β),interleukin-8,and tumor necrosis factor-α(TNF-α) gene expression were as...     

Decreased IgA+ plasma cells and IgA expression in acute liver necrosis mice

AIM: To investigate the number of intestinal immunoglobulin A (IgA+) plasma cells and expression of intestinal IgA in mice with acute liver necrosis. METHODS: A model of acute liver necrosis was established by intraperitoneal injection of galactosamine (GalN) and lipopolysaccharide (LPS). Sixty mice were randomly divided into one of 4 equal groups: normal control, acute liver necrosis, LPS, or GalN. Hematoxylin and eosin staining, immunohistochemistry, and an enzyme-linked immunosorbent assay were employed to assess liver and intestinal injury, count intestinal IgA+ plasma cells, and measure the expression level of IgA and interferon γ (IFN-γ) in the small intestinal mucosa of mice. RESULTS: Injured intestinal mucosa was observed in the acute liver necrosis group but not in the normal, LPS or GalN groups. Compared with the normal group,intestinal IgA+ plasma cells were slightly decreased in the LPS and GalN groups [429 ± 20 per high power f ield (HPF), 406 ± 18/HPF, respectively], whereas they were markedly decreased in the acute liver necrosis group (282 ± 17/HPF vs 495 ± 26/HPF in normal group, P < 0.05). The expression of intestinal IgA was also slightly decreased in LPS and GalN groups, but was markedly reduced in the acute liver necrosis group as determined by enzyme-linked immunosorbent assay (P < 0.05). In contrast, the level of IFN-γ was slightly increased in LPS, GalN and acute liver necrosis groups, but with no statistical signif icance (P > 0.05). CONCLUSION: Intestinal IgA+ plasma cells and IgA expression levels indicating that mucosal immune barrier dysfunction, does exist in acute liver necrosis.